Misumida Naoki, Pagath Mariah, Ogunbayo Gbolahan O, Wilson Ryan E, Kim Sun Moon, Abdel-Latif Ahmed, Elayi Claude S
Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington.
Catheter Cardiovasc Interv. 2019 Jun 1;93(7):E385-E390. doi: 10.1002/ccd.27915. Epub 2018 Oct 9.
We aimed to investigate the current practice patterns of permanent pacing, especially the timing of implantation, for high-degree AV block (HDAVB) following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR).
Comparative data regarding current practice patterns of permanent pacing for HDAVB between TAVI and SAVR is limited.
Using the National Inpatient Sample database, we identified patients who underwent TAVI or SAVR between 2012 and 2014. The incidence of HDAVB, the rate of permanent pacemaker implantation, and the timing of implantations were compared between TAVI and SAVR groups.
We identified 33 690 and 202 110 patients who underwent TAVI and SAVR, respectively. HDAVB occurred in 3480 patients (10.3%) in the TAVI group and 11 405 patients (5.6%) in the SAVR group (P < 0.001). Among the patients who developed HDAVB, patients in the TAVI group were more likely to undergo permanent pacemaker implantation than those in the SAVR group (74.1% vs 64.7%; P < 0.001). The median interval from TAVI to pacemaker implantation was 2 days (interquartile range 1-3 days) vs 5 days (interquartile range 3-7 days) from SAVR to pacemaker implantation (P < 0.001). Among the patients who developed HDAVB, TAVI was associated with higher rates of permanent pacemaker implantation after adjusting for other comorbidities (odds ratio 1.41:95% confidence interval 1.13-1.77; P = 0.003).
HDAVB occurred more commonly after TAVI compared to SAVR. HDAVB after TAVI compared to SAVR was associated with a higher rate of permanent pacemaker implantation at an earlier timing from the index procedure.
我们旨在研究经导管主动脉瓣植入术（TAVI）和外科主动脉瓣置换术（SAVR）后高度房室传导阻滞（HDAVB）的永久起搏当前实践模式，尤其是植入时机。
关于TAVI和SAVR后HDAVB永久起搏当前实践模式的比较数据有限。
利用国家住院患者样本数据库，我们确定了2012年至2014年间接受TAVI或SAVR的患者。比较了TAVI组和SAVR组中HDAVB的发生率、永久起搏器植入率以及植入时机。
我们分别确定了33690例接受TAVI的患者和202110例接受SAVR的患者。TAVI组中3480例患者（10.3%）发生HDAVB，SAVR组中11405例患者（5.6%）发生HDAVB（P<0.001）。在发生HDAVB的患者中，TAVI组患者比SAVR组患者更有可能接受永久起搏器植入（74.1%对64.7%；P<0.001）。从TAVI到起搏器植入的中位间隔为2天（四分位间距1 - 3天），而从SAVR到起搏器植入的中位间隔为5天（四分位间距3 - 7天）（P<0.001）。在发生HDAVB的患者中，调整其他合并症后，TAVI与更高的永久起搏器植入率相关（比值比1.41：95%置信区间1.13 - 1.77；P = 0.003）。
与SAVR相比，TAVI后HDAVB更常见。与SAVR相比，TAVI后HDAVB与在索引手术更早时间进行更高的永久起搏器植入率相关。
